Individual provider Active NPI

Alaa Etouni

  • Physician Assistant
  • Bronx, NY
National Provider Identifier
1104633098
Registry record updated Dec 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1825 Eastchester Rd
Bronx, NY 10461-2301
Phone
(718) 904-2400
Fax
(718) 904-2827
NPI assigned
Dec 13, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1825 Eastchester Rd
Bronx, NY 10461-2301

Mailing address

1571 Meadowbrook Rd
Merrick, NY 11566-1920
Phone (347) 394-6348

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250528001150 NY Practitioner - Physician Assistant 3274052717 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
033242NYMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Mar 4, 2025 Accepting new patients
Montefiore Medical Center CurrentSince Mar 4, 2025 Accepting new patients

Locations

1825 Eastchester Rd
Bronx, NY 10461
Phone (718) 904-2000

111 E 210th St
Bronx, NY 10467

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: aetouni@montefioredirect.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734739200000",
    "number": "1104633098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1571 MEADOWBROOK RD",
            "city": "MERRICK",
            "state": "NY",
            "postal_code": "115661920",
            "telephone_number": "347-394-6348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 EASTCHESTER RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612301",
            "telephone_number": "718-904-2400",
            "fax_number": "718-904-2827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETOUNI",
        "first_name": "ALAA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-13",
        "last_updated": "2024-12-21",
        "certification_date": "2024-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.